Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2] OverviewThe course of hepatitis B may be extremely variable. Hepatitis B has different clinical manifestations depending on the patient’s age at infection, immune status, and the stage at which the disease is recognized.[1] During the incubation period patients may experience flu-like symptoms, such as nausea, vomiting, and headaches. A person infected with hepatitis B virus may recover completely, become an asymptomatic carrier of the virus, develop chronic disease, or develop fulminant hepatitis. In acute hepatitis B, the incubation period may range from 45 to 120 days, depending on the amount of virus in the inoculum, host factors, and mode of transmission. These patients may experience the following symptoms: fatigue, nausea, vomiting, anorexia, abdominal discomfort, and jaundice. In most cases, no special diet or treatment are necessary. The risk of developing chronic hepatitis decreases with age, with infants having the highest risk. Chronic hepatitis may progress to: cirrhosis, liver failure, or hepatocellular carcinoma. In most cases the prognosis of acute hepatitis is good, with symptoms lasting 2 to 3 weeks. However, in infants and immunocompromised persons, the risk of developing chronic disease is increased.[1][2] Natural HistoryDuring the incubation phase of the disease, patients may feel unwell with possible nausea, vomiting, diarrhea, anorexia, and headaches. Patients may then become jaundiced, although low grade fever and loss of appetite may improve. Sometimes HBV infection produces neither jaundice nor other obvious symptoms.[1] Patients with asymptomatic HBV may become silent carriers of the virus, and constitute a reservoir for further transmission to others. Patients infected with hepatitis B may:[1]
In general, the frequency of clinical disease increases with age, whereas the likelihood of being a carrier decreases.[1] Acute Hepatitis B
Incubation Period
Preicteric or Prodromal Phase
Icteric Phase
Convalescence Phase
Chronic Hepatitis B
ComplicationsWhile most acute HBV infections in adults result in complete recovery, fulminant hepatitis occurs in between 1 and 2% of acutely infected patients. Approximately 200 to 300 Americans die of fulminant disease each year. Although the consequences of acute HBV infection can be severe, most of the serious complications associated with HBV infection are the result of chronic disease. Approximately 25% of carriers develop serious liver disease such as chronic hepatitis, cirrhosis, or primary hepatocellular carcinoma. Common complications of hepatitis include:
Hepatocellular Carcinoma
Associated DisordersHepatitis B infection is associated with several disorders characterized by immune complex deposition. These include polyarteritis nodosa, membranous nephropathy, and Gianotti-Crosti syndrome. Polyarthritis Nodosa
Membranous glomerulonephritisHBV-associated membranous glomerulonephritis is more common in children than in adults, where spontaneous remission is seen in up to 60% of patients within 1 year. Spontaneous resolution of HBV-related membranous nephropathy is not a common finding among adults, especially in patients living in endemic regions. These patients often develop complications related to overt nephrotic syndrome. Remission of membranous nephropathy is associated with clearance of the HBeAg from the serum.[1][7] Papular acrodermatitis of childhood (Gianotti-Crosti syndrome)Gianotti-Crosti syndrome is a distinctive disease of childhood. Patients present with skin lesions, lentil-sized, flat, erythematous, and papular eruptions localized to the face and extremities and lasting 15 to 20 days. The disease is accompanied by generalized lymphadenopathy and hepatomegaly. It is associated with acute anicteric hepatitis B of ayw subtype.[1] Prognosis
References
Template:WH Template:WS In what stage of hepatitis does jaundice occur?Icteric phase: After 3 to 10 days, the urine darkens, followed by jaundice.
How does hepatitis B cause jaundice?It is sometimes called “yellow jaundice” because the liver injury from hepatitis may cause an increase in bilirubin. Bilirubin is a chemical in the blood that can cause the skin to turn yellow. The hepatitis B virus can live in a person for his or her whole life. A blood test can show if the virus is present.
What is the onset of hepatitis B?The incubation period of the hepatitis B virus ranges from 30 to 180 days. The virus may be detected within 30 to 60 days after infection and can persist and develop into chronic hepatitis B, especially when transmitted in infancy or childhood.
What happens during hepatitis B?Chronic hepatitis B can develop into a serious disease resulting in long-term health problems, including liver damage, liver failure, liver cancer, and even death. There were 1,649 deaths related to hepatitis B virus reported to CDC in 2018, but this is an underestimate.
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